A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia

Han-Mo Chiu ¹, Chi-Yang Chang ², Chien-Chuan Chen ¹, Yi-Chia Lee ¹, Ming-Shiang Wu ¹, Jaw-Town Lin ¹, Chia-Tung Shun ¹ and Hsiu-Po Wang ^1*

¹ National Taiwan University Hospital, Taiwan
² E-Da Hospital, I-Shou University, Taiwan

^* To whom correspondence should be addressed. E-mail: whp{at}ha.mc.ntu.edu.tw.

Accepted 5 September 2006

Abstract

Background: Discrimination between neoplastic and non-neoplastic lesions is crucial in colorectal cancer screening. Application of narrow-band imaging (NBI) in colonoscopy visualizes mucosal vascular networks in neoplastic lesions and may improve diagnostic accuracy.

Aim: To compare the diagnostic efficacy of NBI in differentiating neoplastic from non-neoplastic colorectal lesions with diagnostic efficacies of standard modalities, conventional colonoscopy, and chromoendoscopy.

Methods: In this prospective study, 180 colorectal lesions (in 133 patients) were observed with conventional colonoscopy, and, under low- and high-magnification NBI and chromoendoscopy. Lesions were resected for histopathological analysis. Endoscopic images were stored electronically and randomly allocated to two readers for evaluation. Sensitivity, specificity, and diagnostic accuracy of each endoscopic modality was assessed by reference to histopathology.

Results: NBI and chromoendoscopy scored better under high than under low magnification in comparison with conventional colonoscopy. The diagnostic accuracy of NBI with low or high magnification was significantly higher than that of conventional colonoscopy (low magnification: p=0.0434 for reader 1 and p=0.004 for reader 2; high magnification: p<0.0001 for both readers) and was comparable to that of chromoendoscopy.

Conclusion: Both low- and high-magnification NBI were capable of distinguishing neoplastic from non- neoplastic colorectal lesions and the diagnostic accuracy of NBI was better than that of conventional colonoscopy and equivalent to that of chromoendoscopy. The role of NBI in screening colonoscopy needs further evaluation.

Keywords: chromoendoscopy, colorectal neoplasia, magnifying colonoscopy, narrow-band imaging (NBI), sensitivity and specificity

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